Emotion regulation, executive functioning and quality of life following stroke : a research portfolio

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Abstract

Systematic review
Executive dysfunction is commonly reported following stroke with most research in this area
focused on frontal lobe lesions. A systematic review was carried out to evaluate the
evidence of executive dysfunction following stroke as compared to control groups. It was
found that executive functions are consistently impaired following stroke and is not limited
to frontal lobe lesions. Processing speed, mental flexibility, attention and working memory
impairments were found to be the most common executive functioning impairments
following stroke. Given the impact executive dysfunction may have on successful
rehabilitation, relationships, return to work and quality of life, a comprehensive assessment
of such difficulties is important following stroke to aid in the development of appropriate
and effective rehabilitation strategies. Future research should use larger samples and a wide
range of measures to assess different aspects of executive functioning.
Introduction
Mood disorders and psychological distress are common following stroke, and depression and
emotional lability have been studied extensively. There has, however, been little research
into difficulties in emotion regulation following stroke and whether this is associated with
emotional or cognitive difficulties. The current study investigated emotion regulation
difficulties following stroke and their relationship with quality of life, executive functions,
anxiety and depression.
Method
Fifty participants who had suffered a stroke and forty five age matched controls completed
the Difficulties in Emotion Regulation Scale, the Hospital Anxiety and Depression Scale, the
World Health Organization Quality of Life assessment – Brief version and the National
Adult Reading Test. In addition individuals with stroke completed four measures of
executive functioning – Color Trails Test, Verbal Fluency, Brixton Spatial Anticipation Test
and the Hayling Sentence Completion Test.
Results
Individuals with stroke had significantly greater difficulties in emotion regulation compared
to age matched controls and this was significantly associated with lower self reported quality
of life and increased levels of both anxiety and depression. No significant associations were
found between emotion regulation and executive functions or between executive dysfunction
and lower self reported quality of life.
Discussion
The current study found evidence that individuals who have suffered a stroke have more
difficulties in emotion regulation than an age matched control group. This is clinically
important as emotion regulation difficulties are found in mood disorders and it may be that
such difficulties precipitate and/or maintain depression following stroke. The absence of an
association between difficulties in emotion regulation and executive functioning suggests
that other factors may influence such difficulties, such as the trauma of having a stroke.
Future research should explore emotion regulation difficulties further following stroke,
particularly investigating whether the course of these difficulties changes over time and if
they are linked to type of stroke or lesion location.